A blog about home birth, pregnancy, childbirth, motherhood and all that good stuff.
(blog formerly named What Ifs and Fears are Welcome)

Monday, July 9, 2012

A Birth Doula's Take on Home Birth

I fell in love with the idea of a birth at home when I was
pregnant with our first child. Here's us, with my preggo belly :)

I had devoured Ina May’s Guide to Childbirth, watched the movie The Business of Being Born, read that 2005
Johnson and Davis article in the British Medical Journal, met some amazing
midwives that seemed to have an answer for me about everything childbirth-related, and was introduced to this new,
wonderful community of women that all doted on home birth and its safety. I was
sold. I wanted a home birth. I wanted empowerment, water, privacy, minimal
interventions, and the safest, most peaceful entry into the world that I could
possibly give my child.

So during my pregnancy, along with studying to become a
birth doula, I spent my time fighting our insurance company (because they
wouldn’t pay a dime for a home birth), reading more books about natural
childbirth and information that supported the safety of home births, and trying
to prepare myself, my husband, and our home for our first child. A few weeks
into my third trimester, I got one final letter back and it sealed our birthing
fate. Our fight was over… the insurance company was NOT going to pay for our home
birth. We were covered 100% for our OB care and hospital
birth – I didn’t even have co-payments; our home birth would have cost $4500+. A baby on the way, buying a new house... OB
and hospital it was. I was devastated and scared.

To make a long story short, I’ll fast forward about 2 years and
give some highlights along the way: we had a baby boy in the hospital and it
was a really good experience (I was
actually shocked but our nurse and doctor were both very kind and I somehow
managed to get out of there with a med-free birth as I had hoped and a healthy
baby who was breastfeeding like a champ); a few months later, we switched our
insurance companies to one that would pay for 80% of a home birth (our hospital
birth was great, so can you imagine what our home birth will be like for our
next child? Can we start on Baby #2 now, please?!); I started to attend births
as a doula at home, birth center, and hospital; I became a certified birth
doula through DONA and began the process of becoming a childbirth educator
through ICEA; I was a part of an emergency home birth transfer that left me with many questions; I started to go outside my comfort zone by reading material and
information that was against home
birth; I started to doubt some of the things
I had learned – and swore by – regarding home birth; I got pregnant with Baby
#2 and started debating if I was really convinced of the safety of home birth; my
husband and I ultimately decided we did not want to give birth at home; I
decided I could no longer support mothers as a doula at home births because home
birth here in the USA was no longer something I supported at all.

Talk about a 180! And that’s where I am today. I am a birth
doula who does not support home birth. You won’t find a lot of women in my
community who aren’t all about home birth let alone someone who doesn’t support
it at all. Not so long ago, I was
like the majority who support home
birth and like the majority of mothers who have
a home birth: I was a non-expert who read enough material and talked to enough
of the right people in the home birth community that had me convinced of its
safety.

What changed?

Do I Really Need to
Fear my Hospital?

I can’t lie; a huge source of my hospital fear came from
watching the movie The Business of Being
Born. It wasn't just that movie - but being a film it painted a very real, and scary, picture of what I was reading about all over the place -- it shares that same message regarding hospitals that is echoed loudly in the home birth community, even the natural childbirth community. I didn’t want some passionless OB who had some kind of hidden agenda.
I didn’t want to be stuck in a bed to labor. I didn’t want to be swept up in
the “cascade of interventions” that could possibly lead to an unnecessary
c-section. I didn’t want to end up with drugs in my and my baby’s systems. I
didn’t want extra hurdles that would make breastfeeding more challenging. I
didn’t want any of it and I was surely scared of it. What I knew at that time
was that childbirth would be just as safe at home or in hospital, so then why
not be in a place where I can avoid all those discomforts and interventions? I could be in the comfort
of my own home and have someone taking care of me that I knew would be truly
passionate about childbirth.

But then we had our hospital birth. And it was really nice.
I didn’t even end up with myOB,
I had one of her partners on call – whom I’d never met – and she was great. No
one pushed interventions, I wasn’t stuck in bed when I labored, I could squat
when I pushed, and I held my baby the second he was born. And the hospital
births that I attended as a doula, those were pretty awesome, too. Wow, there are actually some fantastic
OBs and nurses out there who love what they do. What was all this? Was avoiding interventions really such an impossible
task? Were hospitals and OBs really all that scary? Maybe hospitals circa now aren’t so shabby after all?

Experts in Normal Birth

The whole idea behind having an “expert in normal birth” for
my pregnancy and birth sounded so right-on: I wanted someone who knew how to attend
to a woman in a labor and allow me to give birth vaginally with as little
intervention as possible. I believed (and still do) that pregnancy is a normal
and healthy event usually… but, I
couldn’t help but wonder, maybe I should think about this from another angle?
What if things become not-so-normal? What then? Yes, a home birth midwife is trained to
identify when things become complicated, but maybe I want someone who can not
only identify any issue but someone
who can also remedy any issue with
any technology or equipment needed to do so (or immediately turn over my care
to someone who can, say if I was under the care of a CNM in a hospital).

So what about OBs? As our c-section rate in the US
proves to us, most of the deliveries an OB oversees are
vaginal, not surgical (though some or many think too many are surgical). Yes,
majority of them may not be “normal” due to interventions but is that the OBs fault? Or is that the woman’s choice? Most women want an epidural (an intervention). Are OBs
supposed to deny a woman an epidural so they can attend only “normal births?”
Of course not.

OBs see and deal with and train for every type of scenario
that can come up during childbirth: from “normal” to post partum hemorrhage to
vasa previa to newborn diaphragmatic hernias to amniotic fluid embolism to
cardiac arrest to much, much more. They are experts in all things birth-related.

Telling myself “that won’t happen to me… complications are
rare… birth is almost always normal” wasn’t going to work. What
if my next birth veers outside of that range of “normal?” Or what if it veers way outside of that range? If we
transfer to a hospital, from a financial perspective, I then have to pay my home
birth midwife plus a hospital (and
potentially an ambulance, too). And, no, I completely understand it’s certainly
not all about money. You can’t put a price tag on the safety of you or your baby. But the truth is, many women have a home birth
because it’s the more affordable route… and if they transfer, what then? They
end up with two (or more) bills to pay instead of one.

I have met some of the most amazing, well-educated, caring
home birth midwives that exist in the US
(CNMs and CPMs). Their track records are astounding. There’s no doubt they love
what they do and they are good at what
they do. But my what if’s had
officially run wild and there was no reeling them back in without something
concrete. I truly love the midwifery model of care so I considered a hospital
CNM but they aren’t offered through our hospital – and I actually really liked
our hospital now. Plus, my OB and I developed a really
great relationship. My office visits with her are personal and I don’t feel
rushed. I started to feel so torn… my gut was telling me I should go with my OB
but my heart was still leading me toward home birth with a midwife.

So now what? Statistically, which is safer: home birth or
hospital birth?

The Confusing
Statistics and Many Types of Midwives

If you try to look at this statistically - home birth safety
vs hospital safety - it’s more confusing than trying to understand a debate in
a foreign language. One study will show that home birth is just as safe as
hospital birth (the 2005 Johnson and Davis Study in the British Medical Journal)
and another study will show that home birth has triple the death rate of hospital
birth (the 2010 Wax Study in the American Journal of Obstetrics and Gynecology).
Which study is better? Which is more thorough? Which is more accurate?

How was I to know if
the authors of the study haven’t made any errors? What if they are coming from
a biased standpoint, could that affect their outcomes? There are critics on
both sides of the home birth debate that will point out the flaws in both of those studies - or in any study (or even data) that you will be
able to find. Basically what we’re left with is this: in the United
States, we don’t have any studies that have
been performed to accurately assess how safe or unsafe home birth is. It truly
doesn’t exist. For various reasons it doesn’t exist… from the way death
certificates vary from state to state to the fact that home births midwives aren’t
required by law to report their outcomes (except in Colorado). A thorough and
accurate study of the safety of homebirth in
the US
versus hospital birth in the US,
does not exist.

So what about comparing childbirth-related death rates in
the US where the majority of births take place in a hospital, to
childbirth-related death rates in other first world countries where home birth
with midwives is much more common? This could
be a good indicator of whether or not home birth is safe, right? Well, there
are two big problems there:

1. Which
type of death rate do you consider?

2. If
we compare midwives in foreign countries to midwives in the US
are we comparing apples to apples?

I’m using the most recent data that I could find. Since home
birth advocates often compare the US
to the Netherlands,
that’s what I will do.

Often when people refer to safety of childbirth, they use
the infant mortality rate. If you consider infant mortality, then yes, the US
doesn’t do so well when compared to other first world countries that have a
higher rate of home births with midwives - the US infant mortality rate is higher than the Netherlands.1
But what is infant mortality?

Infant mortality refers to the death of a baby within the
first year of life.2Infant mortality does not include intrapartum fetal deaths (when a baby dies during labor and delivery). Again, infant
mortality refers only to babies born
alive that die before they turn one. If a baby dies at 4 days old or 364 days
old it will affect the infant mortality rate. So yes, it includes pregnancy and
birth-related issues that may later cause a death like birth defects, low birth
weight and neonatal hemorrhage but
also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate.

Makes you wonder… is comparing infant mortality rates
between countries really the best way to determine if childbirth in that
country is safe or not? Is there another mortality rate that is more specific
to childbirth? Yes, there is. Actually, there are two: perinatal mortality and
neonatal mortality.

Perinatal mortality refers to death around the time of
delivery and includes both fetal deaths (of at least 20 weeks of gestation) and
neonatal deaths (death during the
first 28 days after live birth – neonatal deaths obviously then determines the
neonatal mortality rate).3 Neonatal mortality is encompassed
within perinatal mortality. Seems to me that perinatal mortality is the more
accurate way to assess the outcomes of pregnancy and childbirth… that’s because it actually is.

So, how does the US
compare to other countries in this regard? We do quite well! The US perinatal mortality rate
is actually lower than the
Netherlands.4

Now you have to
compare the types of midwives they have in other countries to what we have here
in the US. Again,
I’ll stick with the Netherlands.

The midwives in the Netherlands
must first be accepted into one of four higher education academies. Each
academy follows a strict four-year curriculum and is for full-time students
only. Approximately half of the curriculum is practical internships and the
other half is studying science-based medicine. Once you graduate and become a
professional midwife, you can work either as a midwife who attends home births
or who attends hospital births. A home birth midwife in the Netherlands
has hospital privileges even if that is not where they primarily work. Low-risk
pregnant women have an option of home birth or hospital birth with a midwife
but if the woman becomes high-risk or if complications arise during pregnancy,
labor or delivery, she is referred (or transferred) to an obstetrician.

In the US, it is very different. There are three main types of midwives in the US: Certified Nurse Midwives (CNM), Certified Midwives (CM), and direct-entry midwives. Direct-entry midwives refers to Certified Professional Midwives (CPM), Licensed Midwife (LM; which is essentially a CPM that has been licensed to work in a particular state); and, lay midwives (no certification, education or training requirements - technically anyone can call themselves a midwife).

Though some CNMs and CMs attend home births, most work in hospitals - the training and education of a CNM or CM is more similar to the training and education of a midwife in other developed countries.

Mass majority of home births in the US are attended by some sort of direct-entry midwife (a CPM, LM or lay midwife). The typical route to become a CPM or LM (and most popular route of all currently practicing CPMs and LMs) is the Portfolio Evaluation Process which consists of an apprenticeship program and passing a skills assessment and one written exam. The time length to become a CPM varies on an individual basis.

If a CNM or CM hascurrenthospital privileges, then she may be able to continue care alongside the hospital staff in the event of a transfer. CPMs and LMs do not have hospital privileges and are legally regulated in only 26 states.

When you consider education and training requirements in addition to hospital privileges, you aren’t comparing apples to
apples at all when you’re looking at home birth midwives from one country to
the next.

After taking all
of this into account, I was no longer sold on the safety of home birth based on
any of the studies or data or comparisons of rates or midwives from country to
country. The whole idea of having some sort of statistical proof to back up our
home birth beliefs flew right out the window. I suddenly felt like I was
grasping at straws… was I?

What else can I consider? If I stayed low-risk in my
pregnancy, I believed the odds would be in my favor. And if things were starting
to veer into not-so-normal-land at our home birth, my midwife would catch it
and we’d just go to the hospital, right? But…

Is Our Hospital
Really Close Enough?

Have you ever heard a woman defending her choice to have a
home birth by saying “we only live 5 minutes from the hospital if something
comes up.” Well… is that really the
case?

Have you ever seen a woman in active labor? They don’t move
very fast. Even if you live across the street from a hospital, it’s going to
take you longer than 5 minutes to get her there – or simply just to get her out
of the door. Now if it’s a situation where the midwife sees a potential
emergency happening before it actually becomes
an emergency, then getting to the hospital in time might not be a big deal at
all. But what if it’s a situation where every minute matters (which it can be –
and with little to no warning – even for a low-risk mom with previous vaginal
births)?

Things to consider if it becomes one of those
every-minute-matters situations: Do you know approximately how long it will
take for an ambulance to arrive at your home? Is traffic something you need to
worry about? Does your midwife have complete and accurate records for you and
will she have them when you’re in labor to take to the hospital (blood type
record is important)? If you don’t
go via ambulance, the hospital likely won’t even know you’re coming (unless
someone calls ahead) so do you know what your hospital’s protocol is when a
woman comes in during active labor in an emergency situation? Depending on the
type of hospital it is, that can make a huge difference in how fast they can
get you the help you need.

One of the home births I attended as a doula was a hospital
transfer. For that particular transfer, it took over an hour from the time the
decision was made to go to the hospital until the baby was delivered… and this
was one of those every-minute-matters emergencies. One second everything was
great and the next, it wasn’t. The midwife said an ambulance would take too
long, so that idea was quickly vetoed (and for good reason). On the way, the
midwife called the charge nurse at the hospital in the Labor and Delivery unit to
let her know we were coming so they could be ready for us. The mother had also
seen an OB during her pregnancy so the hospital already
had her records. We were only 6 miles away from the hospital, it was mainly freeway, and we hit zero traffic. The baby was stationed low
enough that the OB was able to use a vacuum to get the
baby out (if a c-section were needed, it would have taken more time). All those
things considered, it still took over
an hour from the time the midwife said “we need to go to the hospital” until
that baby was out.

Be honest with yourself. How long do you really think it will take for you to get
to a hospital? We’re not just talking door-to-door here. We’re talking from bed
or bath or where ever you are laboring in your house all the way into a
hospital and in the right hands at
the hospital. An emergency in childbirth
can happen with little to no warning even for a low-risk mother, even with the
most skilled caregiver in attendance. If it’s an emergency for something
like cord prolapse and if that baby is being seriously deprived of oxygen and
blood, then you can see how every single second becomes precious. Is cord
prolapse common? No (it is more common if your baby is breech, though). But is
“not common” good enough for you when it comes to your baby’s life? Or what if
your baby just goes into distress for no reason? The home birth transfer I
mentioned above was for a young, healthy mother with a textbook low-risk
pregnancy. Baby just stopped tolerating labor for no apparent reason and went
into distress (perhaps his cord was being compressed? Changing positions did
nothing to help so who knows what it was).

Just a quick side note… Your midwife isn’t going to have a
vacuum with her and neither is an ambulance. Nor will your midwife or an EMT be
able to perform an emergency c-section. Believe it or not, there are many that
do not know this.

When we really took into account our distance from a
hospital, it scared the crap out of me… could we really get to a hospital in
time? Even if my body was pumping out enough adrenaline for me to fly there,
would that be fast enough in an emergency? What
if minutes matter for my child’s life or well-being? What if it matters for
my own life or well-being?

BUT… “Babies Die in
Hospitals, Too”

Yes, they do. And this was something I, too, once argued to
defend home birth. But again - putting things into perspective - when, in the
past 10 (even 20) years, is the last time you heard of a full-term baby who
died in a hospital born to a low-risk mother?

More importantly, I had to ask myself: how many healthy, full-term babies are dying in hospitals that otherwise would have lived had they been born at home?

I’ve heard plenty of stories of babies that were born
prematurely that died in a hospital, or babies that died in a hospital because of
severe congenital defects, and etc. So yes, it’s very sad but true: babies die
in hospitals, too. But for full-term babies, it’s not often. Not often at all.

A Woman’s Right to
Choose

Yes, I know… ultimately, what it all comes down to is that
women should be allowed their own choice of where to give birth and with whom.
After all, it’s “her baby, her body.”

The HUGE problem with that is: in order for a woman to make
an informed decision about her baby and her body, she needs to have all of the
information in front of her. She needs to know what is considered high-risk and needs to know why it is considered high-risk. Even if
the mother is low-risk and a “perfect home birth candidate” it doesn’t mean
that birth can’t be dangerous to a point where minutes can mean the difference
between life and death… or life and severely physically or mentally injured.

I recently had a conversation (via Facebook commentary) with
a home birth supporter (she may even be considered a home birth activist to
some, perhaps even to herself – I don’t know). In her comments she wrote, “yes, there are bad midwives out there- I have no idea how
many. No one does. But I do know that there are also many midwives who are
cautious and do not deserve to be lumped in with the reckless ones. And the
women who proceed cautiously when choosing home birth also don't deserve to be
lumped in with those who take on many risks… A quick google search and you can
find all sorts of information that lets you know that giving birth at home when
you are high-risk is a bad idea…. Some people don't want to know the reality of
a situation and that is their deal. What can you do if they are not willing to
listen? And I am speaking for myself because I can't speak for anyone else. But
if you are choosing to do a VBA3C twin birth at 42 weeks at home.. I mean, come
on, you better own that choice.”

That’s just it. That right there hits
the nail on the head for me and is the number one reason I have a huge issue
with home birth in the US. Doesn't every
woman think she is proceeding cautiously when choosing home birth and her home birth midwife? How does a
woman know her midwife isn’t one of those “bad midwives” who simplifies very high-risk
situations? How do you know your midwife is giving you true informed
consent? A woman trusts her midwife implicitly – no
woman would knowingly risk her child’s life!

Homebirth midwives in the US
vary so greatly in their training,
their education, and their philosophy
of childbirth. There are many, many midwives in the
US - and well-known ones like Ina May Gaskin - who take on high-risk mothers.
What may be considered high-risk to one midwife may just be considered a
“variation of normal” to another. Even if a midwife acknowledges a high-risk
situation, if she tells her client that she knows exactly how to handle it,
what is the client supposed to do? No matter how well-read a woman (and/or her
partner) may be, she is not expected to know what her midwife does. If you can't trust your professional caregiver
to tell you when things become too risky, then who the heck can you trust?
Google?

There seems to be a very fine line
between "proceeding with caution" (which is apparently what women are
supposed to do) and "living in
fear" (which is apparently what women are not supposed to do). How does a woman know on which side of the
line she falls?

No midwife or OB wants to see anyone
harmed of course. But at least an OB has the fear of a
lawsuit, fear of losing their job, and fear of losing their license to keep
them in check. A home birth midwife doesn’t. You could essentially be a midwife’s
guinea pig and not even know it.

Not For Me My
Baby

I was filled with doubt about the safety of a home birth and
the proof I once believed in, no longer existed. I was done grasping. All those
sayings and ideas that once meant so much to me: home birth midwives are
“experts in normal birth,” high-risk situations like breech presentation are
just a “variation of normal,” we should all “birth without fear,” and of
course, just “trust birth,” did they really mean enough to me anymore? What
once sounded so profound to me eventually became more like horrible clichés
than anything else.

I do believe that birth is normally safe for low-risk pregnant women but that was not enough
for me. It did not matter how many amazing home births I could witness or read
about. I couldn’t base my decision on anecdotes alone. My baby’s life deserves
more consideration than just anecdotes. That proof… that proof of safety…
I couldn’t find it. I still can’t. The
appeal of home birth is still there… I don’t think it will ever go away. But how
could I choose a home birth now? How could I even attend one as a doula?

I know some will think that I just don’t know enough about
home birth or that I just don’t “trust birth” enough. Well, the latter is
certainly true. If all it takes is to “trust birth,” why do some babies die at
home births from issues that were very likely preventable or treatable in a
hospital? I can’t help but think of the woman whose labor ended with a
placental abruption at her home birth and her baby who didn’t survive it – and she
was a perfect home birth candidate:
low-risk, previous vaginal birth, healthy… or the woman whose attempted breech
delivery at a home birth also ended with the death of her child after his head
became stuck for more than 10 minutes... or the many others. I read their
stories, I saw their photos, and I cried. Did those babies die simply because
those moms didn’t “trust birth” enough? No. No, of course not.

I promise you that you are going to find anecdotal stories
to support either side of this debate: scary hospital births, scary home
births, happy hospital births, happy home births. You’ll find studies and
statistics and data that seem to support either side. So how do you choose? When you find
yourself confused about what to believe or who to believe and your baby’s life is at stake, perhaps fear is
just your instinct in disguise.

I very much like this! The one piece of information I'd add is that despite the Netherland's midwives' higher levels of training, there is evidence that the low risk women delivering with midwives in the Netherlands have higher rates of mortality than the high risk women who deliver with OBs. http://www.bmj.com/content/341/bmj.c5639?variant=abstract

Good for you! I'm sure you'll get a lot of flak from the natural birth community, especially homebirthers, but you are right ON. I also have come to this same train of thought and I am glad you wrote such a cohesive article about it! Thank you!

Why do you have my name written as though it's a fake name?? You can search me on the internet. It's my real name, first and last, with a photo of me right there. What is your name, by the way, "Anonymous?" Too afraid to add it? I am happy sharing my own personal journey with my name attached to it. I'm not a coward.

And yes, sure sure, you know because that's what all of us doulas are all about... we do it for the awesome money. Oh, and the awesome hours, too.

I've lost a lot of connections in my community by writing this and speaking from MY HEART. So clearly, if I was going to do anything for the money, I would have just kept my mouth shut.

I have no idea where you are going with your "small point." ???? You brought up the money thing.... And yes, most doulas charge unless they are new and trying to get births for their certification, then they may not. Of course there are always exceptions, but most doulas do charge for their services.

i just wanted to bring to your attention the tragic story of my baby ~*Vylette Moon*~ 11.28.11 - 12.03.11http://www.facebook.com/justiceforvylette .

because of the extreme negligence of my midwives during thanksgiving weekend.. my child ended up with zero brain activity and i eventually had to remove her from the machines and set her soul free.

i wasn't allowed a homebirth so i went for what i thought the next best thing was - a birthing center. but they couldn't have failed me any worse than they did.

i soaked up all the knowledge i could about natural birth and midwives through reading countless books. i confronted other people about their choice to have c-sections and hospital births. but now being on the other side of the nightmare i live in i start to realize that in the video "business of being born" and in all the Ina May Gaskin books, among other authors.. i never saw statistics on midwives causing deaths. just the cold cold hospital facts. i searched for that sweet motherly compassion and wanted it so much over what i though the coldness of the hospital would be, that i ignored all their cold careless behavior and their rude remarks regarding my weight gain during pregnancy..

in the end even my doula failed me. she never came to my house. thank you for changing your mind and supporting hospital birth. an accident can happen at any time, whether its the midwives fault (as in my case) or just a problem during labour. you need immediate attention and care. things go wrong in hospitals all the time but at least they have the things there to help with an emergency situation should it arise.. instead of wasting precious time sitting in an ambulance.trust me, i would have never said that before, while i was pregnant. but now i realize, after the only thing holding my child here after their horrific 'mistakes' was the room full of machines she was connected to, that maybe modern medicine is here for a reason.

I am so, so sorry for you loss. Thank you for sharing your story of your darling Vylette. I went to your Facebook friend and "liked" your page. I sincerely hope you find the justice you seek.

There needs to be regulation. Perhaps mandatory malpractice insurance would help, who knows. But the way it is currently running is horrible. Our midwifery system in the US is unlike any other midwifery system in a first world country... and clearly NOT in a good way.

Wonderful and well thought out post! I too pondered a home birth because of all the things I had been reading about them. Insurance would not pay and I was hesitant about the what if something was wrong so hospital birth it was. I was so glad I did because my son had a previously undiagnosed a heart defect and was in the place that could help him the best.

Danielle, thank you for a eloquent article. It is written in a very even tone, and hopefully will be read by many.I agree with the concern about "trusting birth". I don't trust it at all, but rather I "respect" birth. I understand how simple or complex it can be, and many of the variations in between. I don't believe that I will have ever seen "everything", and am always surprised at the "low risk women" who have complications and the "high-risk women" how have natural labours.Finally, I worry that the home birth advocates always compare midwives and obstetricians. There is an important person missing-the paediatrician. As how many paeds docs support home birth. Thanks again.

"So yes, it’s very sad but true: babies die in hospitals, too. But for full-term babies, it’s not often. Not often at all."

Just because you personally haven't heard these stories doesn't mean that they don't exist. Trust me, they do. And "often" is relative. I have had the misfortune of being present when a friend lost her full-term baby born via (non-emergent) C-section, without congenital defects. I've also had a doula client birthing in a hospital whose full-term baby died in utero.

Two stillborn hospital births out of a total of about 30 is not just often, it's downright frequent. I've had no friends or clients lose their babies in a homebirth.

While my experience is just anecdotal, so is yours. Perhaps some statistics or links to studies would be appropriate when making claims that full-term loss in the hospital doesn't occur often.

Congenital defects? You think the hospital caused that? We are talking about tragedies at home birth that could have been prevented in the hospital. There are no tragedies in the hospital that could have been prevented by home birth.

As I wrote, "I’m not saying those deaths don’t happen in a hospital… but I personally haven’t heard any of those stories." Trying to use that reasoning that "babies die in hospitals, too" simply wasn't enough for me. I searched for other ways to "justify" having a home birth and couldn't find them.

I would love to provide you with some statistics... but again, as I said in my piece, those are a little hard to come by. Can you provide any? I've done a lot of searching and haven't been able to find any that can't be disputed.

And also, as I've heard many others say, I can't help but wonder.... how many babies have died at a home birth could have been saved in a hospital? AND, how many babies that have died in a hospital could have been saved at a home birth?

I don't know how to get that information so all I can do as use my own experiences, the information that I have been able to find, and my gut to answer those. For me, hospital is where I choose to give birth as it is where I feel my child will be the safest.

Wait there is no tragedy that happens in a hospital that could've been avoided?! Wrong! The use of pitocin is outrageous here in the US. It has caused fetal distress over and over again, which then in turn makes for an emergency c-section. Without the Dr her baby would've died right? What about if a woman was left alone to labor as nature intended (aside from true medical need). I'm not saying that every labor would go smoothly but some of the interventions that Dr's use can cause problems. If you don't understand that then maybe you should do a little more research about pitocin and the epidural.

Nature doesn't really intend anything - it is inanimate and is a compromise driven by natural selection. Natural selection kills.

Also, how do you know you have 'true medical need'? Sometimes it creeps up on you in a textbook 'normal' pregnancy and your child dies at 40 weeks. If you aren't monitoring a pregnancy/labour because it's less 'natural' to do so (in my UK NCT class, we were asked to 'list the reasons why monitoring in labour is bad' - totally one sided!), or 'left alone to labor as 'nature intended' then you could miss vital signs.

Induction/epidural could be avoided in a hospital if there was no need for it, just by the mother saying no. Doctors aren't allowed to carry out interventions if the mother doesn't consent, unless very serious lack of ability to give consent is present (then courts have to be involved unless things are urgent and imminent). Doctors also follow guidance and the newest evidence to give advice to people - it would be against the code of practice to push for something which would be to the detriment of the 'client' i.e. unnecessary intervention. I am in the UK, where things are a bit different, but the principles are the same.If intervention was needed/wanted however, oh great, you are in the right place.

You put your thoughts across very well Danielle, and certainly make some interesting points. You've decided that home birth is not for you and that's absolutely your choice. But what I'm having a very difficult time grasping is why you have decided to stop supporting women who have come to different conclusions than you. It astounds me that you would refuse to support a woman in a home birth, period, just because you wouldn't have one yourself. As a doula, isn't it your job to make sure women are informed of the risks and benefits of their choices but to also respect and support their decisions? It strikes me as vey paternalistic to withhold support from those who don't make the same choices as you. Obviously you have to work in a way that feels right and comfortable but I'm curious what you say to women who enquire about your services if you find they are planning to birth at home?

Well, first, when I signed up to be a doula, I didn't sign over my soul. There was nothing in the literature I received from my certifying agency that stated I must take any client that wants me. I'm allowed to have my own personal beliefs and preferences. I know MANY doulas who would never take a client who is have an unassisted childbirth. How does it make it any different that I won't take clients who have a home birth? It is a personal preference. The doula/client relationship is a two way street... I would never expect a woman (or couple) to choose me as their doula if they weren't 100% comfortable with me. And vice versa.

Second - and most importantly - I don't think it would be fair to any potential client for them to have a doula who isn't 100% supportive of where they want to give birth. Having preferences is one thing - whether or not a client wants an epidural, for example, is up to them and I will support either way, of course. But home or hospital is much more than just a preference. I am certain there are many other doulas out there that would be a much better fit for a couple having a home birth than I would be.

Also, I don't really think it would be fair to a woman (or couple) to put them in the position of knowing my thoughts on home birth. Each of my previous home birth clients asked me how I felt about it. In fact, I'm pretty sure they each asked me why I didn't have one myself. At the time, the truth was we wanted a home birth but couldn't afford it for insurance reasons. But now that truth has changed. I'm not going to lie to a client - that is no way for a doula/client relationship to function. So do you think it would be fair for me to put them in that sort of situation, knowing full well they will very likely ask me why my husband and I didn't have a home birth? I just don't think that would be fair so I'm avoiding that situation.

I simply tell those that who contact me that are having a home birth that I am unavailable.

UK Doula -- Danielle has very clearly said that she thinks homebirth presents a greater risk of death to the baby. It is not paternalistic to refuse to participate in potential harm to a child. My OB believes routine circumcision is wrong. When she delivers a baby the parents want circumcised, she refers them to another doctor for the procedure. I would say Danielle is doing the exact same thing in refusing to attend home births.

I know doulas who will not attend a birth where the mother plans an epidural. I know of at least one doula who will not attend (even if previously booked) if the OB plans to use misoprostol to induce, and she's very vocal about it. I know doulas who will not attend births with particular OBs/midwives or hospitals, and again, they will tell you so openly.

Thank you, Rachel. That's very kind of you to say. I think that is how most doulas practice - or at least, I feel they should. We shouldn't take on clients just b/c we want more and more of experience or money or whatnot. We should take them on b/c we are a good match for the client... if not, we should let them find a doula who is a better match for them. It's only fair to the client.

This is a wonderfully written piece. I am a home birth activist in every sense, I am also a doula. The biggest thing for women I believe is education and choice.I am so glad you found what makes you happy and safe without taking away from those of us who have different views.

Thank you for being able to read this through and appreciate it in your own way. I know many who are activists will turn away the second the notice the way in which the piece is going... which is sad but typical. I think it speaks volumes of the type of home birth advocate (and especially, activist) who is able to read things such as this with an open mind. How can someone claim to be truly educated or well-researched or well-informed if they refuse to look outside of their comfort zone or refuse to read/hear anything that opposes their views?Thank you again.

Thank you for this great column, Danielle. I had much the same experience (except that I wasn't a doula). I was positively terrified of hospital birth, and ended up having not just one but three beautiful births at my local hospital. I get tired of the attitude that the only place you can have a great birth is at home, or that choosing the hospital automatically means you're going to be tied down to a bed and menaced with an epidural needle.

This is an interesting piece, but it seems highly myopic. I have to wonder, how would the author's feelings have differed if she had her first baby in one of the many U.S. hospitals that is downright hostile to mothers who choose a spontaneous, unmedicated birth? I am always thrilled to hear of a mother being respected and treated well during her birth, but especially in a hospital setting since it can be rare is some regions. But this whole article glosses right over the fact that many hospitals simply don't offer respect or choice to birthing mothers. It is based on the fact that the author had a good experience. But her experience does not reflect every woman's hospital experience, so her conclusion cannot reflect every woman's decision.

I am lucky to live in an area with at least one good choice for birthing with respectful caregivers, but there are also some hospitals with shockingly anti-birth attitudes and sky-high c-section rates. Unfortunately, there are areas of our country where women have few choices and no local caregivers who support a physiological birth. Where do these women fit into the view of birth offered here? Should women who want a healthy baby and low-intervention birth as much as the author did choose to stay with the only hospital-based caregiver in town after he tells her that her pelvis is too small and schedules a c-section date at their first appointment? What about an abuse survivor whose greatest fear is the feeling of being paralized and under someone else's control, but whose only hospital choice has an epidural rate over 95% and no caregivers willing to even discuss the option of her having an unmedicated birth? These are not theoretical "worst case scenarios", these are sitations encountered by women I have worked with while they tried to work toward a safe, healthy birth.

It is fine to eschew homebirth for yourself, but it is disturbing that you assume that because you were treated well and don't happen to know anyone who has lost a baby in the hospital, that there is no place in the world for homebirth. Personally, I don't know any homebirthing families who have lost a baby or mother, though I know deaths occur in all types of births. But I answered "yes" to nearly all of the questions about babies dying in a hospital setting. I also know a family who lost a full-term baby during a normal, low-risk labor. Mom was hooked up to a continuous monitor and when the father called the nurse to point out that the baby's heartrate had changed dramatically, she turned off the monitor because she said it obviously wasn't working right and left the room for more than an hour. The baby"s heartbeat was never heard again. I also know two families who lost their mother after purely elective primary c-sections chosen to avoid birthing on a holiday. I'm glad that you don't know any families who have lived this heartache. I know that they are anecdotal, but they are also very real losses that this article seems to brush aside as not important simply because the author doesn't know the families suffering from them.

I never said that hospitals are all perfect. I simply said I cannot personally fear them b/c of what is portrayed in some movie - which is what I initially did. I did not say there is no place in the world for home birth. But I cannot support home birth in the US as it is today. Home birth with a midwife in the US is a system unlike any other in a first world country.

We can only make our choices by utilizing the information we have. I feel safest in a hospital b/c I haven't found anything or experienced anything that would lead me to believe I and my baby wouldn't be safest there. I trust our hospital system more than I trust our home birth midwifery system, that's really all it comes down to. I cannot personally make the choice to have a baby at home simply b/c I want a better experience. I want a good experience, don't get me wrong, but most important to me is my child's safety. Until there is proof that home birth in the US is just as safe as hospital birth in the US, I have to go with my gut and that is for ME to give birth in a hospital.

If you want more women to have the choice having a home birth, then why not strive for a better midwifery system? Perhaps, if it was more regulated, if information on midwives and their history were more readily available, if it were mandatory for them to have insurance, if it were mandatory for them to report their outcomes directly to each state, and etc. then we women could be making more informed decisions. And who knows, if it were regulated as such, then maybe more states would legalize it and then more women would have the option to have a home birth.

And just to add... for me, home birth is something that is forever off our radar. I feel safest with the technology, equipment and staff offered in a hospital. But if our midwfery system drastically changed here in the US for the better, I could see myself maybe someday supporting it as a doula again.

What do you mean by anti-birth? Since most people are born in hospitals I don't really see how they could be anti-birth. Are you trying to say c-sections are not births? I just don't understand what you mean by this at all.

This is a great post, thank you. As you know, I lost my daughter due to negligence in a homebirth. I later learned of deaths before my daughter and there have been deaths since my daughter. I'm baffled as to why she's been supported and I've been blamed.

I will never understand that, Bambi, and my heart goes out to you. I sincerely hope that more people will start to realize how poor our home birth midwifery system is here in the US. I would think the midwives out there who are well trained and who do practice safely would want to stand up against those who practice recklessly but instead, the home birth midwifery 'sisterhood' seems to trump all else... as if nothing is more important than home birth midwifery, no matter how dangerous some midwives may make it.

@Danielle - It's not like that everywhere. There are safe midwives to birth with. It is our responsibility as parents to research our midwives stats such as worse case scenario's, transfer rates etc. One bad midwife shouldn't ruin homebirth for everyone.

Bambi I'm so sorry for your loss! ((HUGS)) I am sorry that your birthing community isn't standing beside you in your grief. Very sad indeed. I hope for emotional healing for you! Please make sure to get the word out in your community about the facts of what happened so it doesn't happen to anyone else.

Anonymous, I know it's not like that every where. Just like every OB is not a monster, neither is every midwife. I personally know home birth midwives that are amazing and take on only truly low-risk clients and practice very cautiously. One bad midwife shouldn't ruin it, no... but what about MANY bad midwives?

And I'm not suggesting that home birth not be an option anymore... but it needs to be more regulated. How can a woman look up any background information on her midwife? Where do you find that information? How do you know it's thorough and accurate? I've heard from CPMs themselves that they can lie on records b/c there is no one to verify what's correct or not. Perhaps if home birth midwives had more accountability... like if they had to turn in their records for each client to the state and the records had to be signed off by the parents themselves, then maybe we could have a way to accurately assess our home birth midwives here in the US and their backgrounds.

Bambi is sadly not the only one who has lost a child at home birth and had the community turn their back on them....

"in order for a woman to make an informed decision about her baby and her body, she needs to have all of the information in front of her. "

There is no way on earth she will ever have all the information that exists or will exist in front of her. As you pointed out, science is fickle, it changes, and can't necessarily be trusted. As you pointed out, every woman/baby pair and labor/birth is different and can't be predicted. As you pointed out, no one can tell you what caregiver or place of birth is going to be best for you when all is said and done. As you admitted, you based your decisions on fear, which is how most women base their birth decisions.

Basing decisions on fear are one way to go about in life. Basing decisions on peace is another way. In a million years, you will never eliminate all the what-if's in birth or life. You could spend a lifetime conjuring them up in your head and still. Copious amounts of fear based on what-if's, especially when it comes to making life and death decisions, tends to become self fulfilling prophesies and a pretty miserable way of life.

Fear is destructive, especially in birth, and has far reaching consequences. The only safety and security lies in peace, even if the outcome wasn't - as they say - optimal. If you feel peaceful about your planned cesarean that has no apparent reason for doing it, I support you. If you feel peaceful about birthing on a mountaintop unassisted, I support you. If you are having a hospital birth because you are afraid of all the homebirth what-if's, find another doula. If you are having a homebirth because of all the hospital what-if's, I am not the doula for you. When it comes down to it, there is no us vs them, hospital vs homebirth, vaginal vs cesarean, natural vs medicated, midwives vs OB's and anyone who operates on that level has their own issues to resolve - it's all ego and pride, which is rooted in fear. This is about respecting life, honoring a mother's connection to know what is right for her and her baby, and knowing that no one can guarantee anything when it comes to birth and accepting responsibility and love. I pray women and couples choose peace when making decisions, which is rooted in love. It is the only real way to guarantee you've made the right decision for yourself.Blessings to you.

Everyone experiences fear in their life.... it's natural... it's what makes us think twice before doing something potentially dangerous or embarrassing or etc. No one can say they live their life 100% without making decisions at times based on fear.

What mom can say she never does things - maybe sometimes by going a little overboard - b/c she fears for her child's safety??

As beautiful as it sounds to never live in fear, it’s unrealistic. Should we let fear run our lives? No, absolutely not. But to let it guide you in certain times is only natural.

This does not make any sense. We should not make the most important decisions of our lives based on fear. I truly believe that we as woman have intuition and through our love for our children, the research that we've done to educate ourselves to the best of our ability and using our intuition we choose what's best when it comes to birth. That may be homebirth, hospital birth, natural, VBAC, birth center or whatever. Everyone has fear but who wants to live in fear and make decisions off of that??? I will never understand your point of view. It's a sad day when someone in the birthing community is encouraging woman to make birth choices based on fear instead of intuition and informed choices.

I truly understand that you have experienced things in your personal life that have lead you down this path. I understand that homebirth is not for everyone. BUT please don't disguise your fear during a personal experience as educating woman. There are risks that every woman should be informed of going into any birth and it's that woman's right to choose what risks she is comfortable with. That is true empowerment.

Yes, true empowerment comes from knowing risks as well as benefits. I completely agree.

I have considered every angle that I could think of in order to support my decision to have a home birth or not. Am I missing anything else? Tell me what else I should consider?

As I said, I am lacking the proof of home birth safety in the US. I considered everything that I could think of to help me decide home vs hospital and when it all came down to it, I had to go with my gut. Everything I could consider led me to choose a hospital birth... in some respects it's due to lack of evidence, in some respects it's due to fear, etc. I don't feel comfortable with home birth. I don't feel safe.

So what matters is not facts, is not safety, but is intuition and "peace"? This anti-rational attitude is dangerous and is not shared by many today, since we know have access to actual information.

Science is not "fickle." Scientific conclusions are always tentative, but they are very much the best method we have for making decisions.

On fear: I don't think that Danielle is advocating living in fear, but some things are worthy of fear because they are dangerous. Fear is a human survival mechanism. A healthy use of fear investigates, sees what actual risks are, and tries to minimize them.

Anonymous' comments in this sub-thread seem terribly ironic. Part of Danielle's "journey" was learning that the fear of hospitals instilled in her by watching BoBB was not supported by the reality of her hospital experience. I see many, many women on the internet admitting their fear of hospitals and surgery and turning to home birth as a more comforting option.

Why is it okay for women to act on their fear of hospitals, but not okay for a woman to act on (what you call) her fear of the homebirth environment?

This is a really great article - thank you for sharing your points of view.This latest chat about fear is curious - wouldn't it be great if we could all base our lives on peace. I was so peaceful in the couple of weeks before my son died at full term last year. That blew peace and 'trust in the pregnancy' for me. I certainly can't trust that my baby will be delivered at the right time, as last time I never went into spontaneous labour at all, even after he had been dead several days.

In this pregnancy, there has been no peace and a lot of fear. That doesn't mean that (most of the time) I can't rationally look at scientific evidence as well as my fears and use them to come to conclusions about what to do. If I didn't have fear, I would not bother with all the research I have put into making this pregnancy as safe as it can be. If we had been slightly more fearful last time, our son might not have died. Pregnancy is a risky state for the human body in many ways and birth is the riskiest day in a person's life statistically (apart from the day of death obviously). I find it comforting that I will be delivering in a hospital, which has midwives, obstetricians and paediatricians around if I need them, rather than a single midwife (even though they are regulated well in the UK) and nosy neighbours and a potential emergency ambulance trip - even though it does not cost extra in the UK, it can't be good for birthing 'peace' to have to do a sprint to the nearest hospital (which may not be your ideal choice) with the threat of you and your baby dying hanging on your mind.

'The only safety and security lies in peace, even if the outcome wasn't - as they say - optimal.' - Amy JonesAmazing! Are you arguing that if you feel relaxed about things, then you are safe and secure? I would consider my 'outcome' to be .... sub-optimal. Am I putting this baby at risk by not being peaceful? Should I take a zen attitude to this pregnancy then - what will be, will be? Or should I thoroughly research ways to make the optimal more likely?

Dani, this is a great piece, and the dialogue you've prompted is fascinating for me to look over, having little background in the topic of home birth. Audrey and I had three hospital births with no drugs, all good experiences. Particularly, I like that you embrace your dealings with fears and what-ifs. Its a feat of emotional responsibility, I think, to recognize and catalog the influence of your natural concerns, rather than cover them up or simply avoid them. If the plan is to pursue publication, you've got a strong start. Can you tell a writer to break a leg?

Thank you very much for this wonderful post. I'm sure alot of people have given you a hard time for it and I just wanted to throw my support your way. I had a CPM homebirth with my son and ended up transferring to the hospital eventually getting a c-section. Thankfully nothing life-threatening ever came up either at home or at the hospital, but I ended up being disappointed with the care and support I received from my midwife and feeling like the reality of birth and homebirth didn't at all match with all the books and stories I'd read. Now, after doing more reading and research I realize I was taking a bigger risk than I realized in working w/a CPM and planning a homebirth. I think women should have the right to choose where and how they give birth but those choices should be with full disclosure so that women (and others involved)can decide how much risk they want to take on. I'm glad to see people talking about the not-so-dreamy realities of homebirth. Not to belittle the people who have had great, awesome, spiritual, etc. births at home but that's not always how it goes!!

If I think long and hard, I find fear in me of having a home birth - for both my and my baby's safety. I also find fear in driving a car, flying, walking alone on a sidewalk, and occasionally not locking my car when parked at my house, which is in a very safe neighborhood - if I think about it enough. There are what-ifs in all of these scenarios, but they do not change my decision to do them.

When I think about having a hospital birth, I am much more afraid.

If I were to make a decision based on fear (which I wouldn't), my decision would be to have a home birth.

Hopefully you'll make such an important decision taking many, many things into account. I took into account and into consideration as much as I could - if you think I have missed anything I am happy to hear your thoughts. In the end, I feel safest in a hospital.

I find it interesting that so many people that have commented in opposition of what I wrote are so hung up on that last line, as if fear is my only driving force. It is not. I thought what I wrote very clearly spelled out the many things I took into consideration.

"You shouldn't live your life in fear. But to deny it or disregard it completely is living life recklessly." -Danielle Repp

"My child's life deserves my acknowledgement of the fact that childbirth can be dangerous. I choose not to live life in denial but instead to weigh my options carefully and make important decisions taking statistics, logistics, risks, benefits, fears, desires, personal experience, personal values, and my gut instinct all into account." -Danielle Repp

"I don't rely on famous quotes by famous people to guide me or to justify my actions." -Danielle Repp

Fear is a survival tool for humans and other animals that evolved to help keep them alive!

How anyone with any common sense could possibly think that giving birth at home with the only assistance from a person with NO REAL MEDICAL TRAINING is as safe as a hospital, where there is life-saving equipment and experts with years and years of training and experience is utterly beyond me.

Women in the U-S and Canada have access to medical care that is the best that HAS EVER EXISTED IN THE HISTORY OF THE WORLD, that our great- great-grandmothers and millions of women in third world countries today would give anything for. That some women think it's perfectly safe to give birth in a Winnie the Pooh wading pool in their living room is the stupidest thing I've ever heard.

I too watched BoBB, and I was immediately convinced I wanted to have a home birth when I did eventually get pregnant (my husband and I want to start trying soon). When something convinces me to change my mind so quickly and completely, I'm skeptical. I started looking up all the information I could find on both sides of the argument. Your blog posts on the matter have been the most level-headed and unbiased I've read so far, and I want to thank you for that.

One thing the movie introduced me to was the existence of birth centers. There is just one in my city, and it is across the street from the hospital I had originally planned to give birth at. The midwives there are all CNMs and have hospital privileges. The birth center has a relationship with the hospital, and I'd be pre-registered there should complications arise and a transfer be necessary.

What's your opinion on birth centers? My feeling so far is that this one is a very happy medium between the comforts of a home birth and the security of a hospital birth. I would love to know what your opinion is on them.

Hi Alison, I think hospital-associated birth centers (overall) are a wonderful route. For me, I would want to meet their back-up OB or OBs earlier in pregnancy (like 2nd trimester). In case you are "risked out" during pregnancy (which could happen at 36 weeks or later), it would be nice to switch to someone who is not a complete stranger at such a vulnerable time. I'd also want to know what a transfer would be like during labor and how it would be typically be handled - that would personally give me some peace of mind to have a general idea if that were to happen. I'd ask your midwife and I'd ask the doctor, too, just to get a feel from both of them.

thank you so much for writing this blog. I am working on obtaining my DONA certification right now. I am also in So Cal and I feel like every other doula I have talked to subscribes to the "hospitals are evil" mentality. I have had two fabulous hospital births (one induction and one natural), but I feel like my experience is diminished because I have not had a home birth experience.... its as if somehow my great birth experiences don't count. I'm passionate about doula work and I really want to see my clients be supported in their decisions with ALL the facts. I watched "The Business of Being Born" & I enjoyed it, but it led me to research the other side and that is how I came across your blog. I like to be informed of all sides of an issue and while I am not anti-homebirth, I definitely do not subscribe to the idea that all hospitals are evil places out to make a buck on you. I have thoroughly enjoyed reading your blog!

Thanks for reading and commenting. There are other doulas out there who prefer hospitals - or at least, don't find them evil - but yes, I get what you mean. Giving birth in a hospital, consenting to any interventions - to some, those things = not-so-natural and not-so-awesome. What matters most is that you feel good about your experiences - and most of all, your healthy little babies.

Welcome to the community! Not sure where you are (location-wise) but if you need any help or have questions about your certification, let me know! Happy to help any way I can.

Hey, I just wanted to thank you for your post. I am incredibly blessed with FIVE children. Two hospital births, and three home births. And I have had all positive experiences. I have always considered myself a home birth advocate, however... Just the past few days I have started reading the "other side" of the story. And I am shocked! I had no idea so many babies were dying at homebirths. I now consider myself "lucky" to have had such healthy home births. And if I have another baby (you never know!!) I will definitely opt for a hospital birth. Thank you for writing your thoughts, information without belittling mothers.

Hi there, Danielle. I am prego with baby #2 (with #1 had a pretty typical hospital birth, wanted meds, got them, loved my ob-that comes in for every birth even if shes not on call) loved my nurses, and had a great experience. My friends's last pregnancy, she watched and became enveloped in BoBB and I am apart of a pregnancy forum where it seems that almost every one recommends this documentary. The way some people believe in and defend this movie feels a little cultish... But I watched some of it and read about it and knowing that it's a documentary (which is basically a one sided debate, never letting the opposition have a chance) I felt uneasy about the information and began researching. A comment in an amazon review lead me to your blog and I am so grateful. This & your blog specifically about the movie solidified my concerns. I have continued reading in other places but you seem the most level headed and unbiased having been a previous BoBB supporter-not to mention that you often give references and citations. I greatly appreciate what you're doing and how you are doing it. All the comments about fear are so bothersome because they are blind to their hypocrisy of fear of hospitals & potential(ly life-saving) interventions. What gets me the most, is that these women (in my app) are the ones that are like 'why would you even take a sip of alcohol, that is such a risk' yet theyre willing to risk their life as well as their babies in a homebirth for the sake of 'comfort' and 'peace' and this pieced together picture of a romanticized home birth. I suppose if i were given a choice between an "ideal" homebirth setting and an unexpected emergency c-section, i would take the emergency c section ANY. DAY. I dont want to risk that I could be one of the 'perfect candidates' where sh-t goes south fast when the opposite outcome is having an less than ideal birth but surrounded by educated professionals (not just one but several) that can quickly, safely and efficiently take care of my baby and me-without wasting precious time getting out of the tub, finding a something to throw over me, try to make it to a car/ambulance, and drive to a hospital. Nope. My baby's worth more than that. And i know crap happens in hospitals too, things dont always work out, but at least then I will know I did the best I could by the baby, surrounded by professionals/etc. I will sacrifice my little idealistic 'dream' of a home birth day for the health my child. After all the research I've done , I've gone to the other extreme (which is unlike me to be extreme about anything) and feel people opting for a homebirth are selfish and have misplaced priorities. Give me a traumatic birth and a healthy baby. Sorry, guess Ive got myself worked up a bit! haha ill blame the hormones ;) Anyway, I'll add though Im pretty middle of the road with meds. I am going to take some birthing classes and opt for a non medicated birth, my ob is on board and supportive. Thanks again for your work. It is oh so important.

I keep wanting to reply but I don't think I can keep my reply short so then I say to myself, "OK, come back to it tomorrow." Then craziness with two kids and my horrible time management skills that came along with our second child (don't be scared, it's not this way for all moms of two;). Anywho, sorry for taking so long to reply.

I'm glad you found my blog and thank you for your comment/appreciation.

Ya know, although there are always exceptions and this is not the case for all home birthing moms, most who choose home birth don't see it as making a trade, as if they are purposely putting their own desires ahead of what is safest for their child. I can only speak for myself though and will say that we never would have considered home birth if we did not believe it was a safe option. We weighed the risks.... but at the time, didn't realize we weren't getting the full picture. There wasn't much to go on at the time regarding studies about home birth safety. The only one was in the British Medical Journal, but I have since found out it is fatally flawed. There are more studies that are coming out now about home birth safety, and I'm sure only more will come in time. Two new ones came out in 2013 and they showed a dramatic increase of risk to a baby born at home (or freestanding birth center) vs born in a hospital. I'm actually doing a blog post about them with a home birth nurse midwife breaking down the studies and giving her interpretation and insight. I'm very excited to publish it. It's taking a while though as she is very, VERY busy!!

You said "surrounded by educated professionals (not just one but several) that can quickly, safely and efficiently take care of my baby and me-without wasting precious time getting out of the tub, finding a something to throw over me, try to make it to a car/ambulance, and drive to a hospital." I experienced that as a doula and it was very scary. Experiencing it is very different than juggling it as a potential "what if." It was definitely a turning point for me. The travel time when minutes matter... it was traumatizing.